脑Willis环前循环动脉瘤的虚拟解剖研究

目的通过VR技术观测脑Willis环及相关动脉瘤的解剖数据,研究动脉瘤的发生与Willis环变异的关系。方法采集前循环动脉瘤患者头颅CT薄层血管扫描影像资料,在立体三维空间内观测并分析动脉瘤的发生与脑Willis环解剖变异的关系。结果 50例患者共57个动脉瘤VR环境下完成重建,三维空间内清晰直观的显示动脉瘤的解剖细节;50例患者Willis环左侧ACA-A1平均管径明显大于右侧;前交通动脉瘤患者ACA-A2夹角为(141.6±19.79)°,非前交通患者夹角为(113.68±16.73)°;12例PCoA-AN患者有7例胚胎型PCA。结论脑血管形态学类型不同是动脉瘤形成的重要因素。VR虚拟解剖较传统尸体解剖相比,具有重复利用性强、避免破坏尸体标本及立体三维解剖研究等独特优势。     

颈内动脉狭窄对大脑动脉环血流动力学影响的有限元分析

目的　大脑动脉环血流变化常与颈内动脉狭窄相联系。本研究试用有限元方法来研究颈内动脉狭窄对大脑动脉环内的血流动力学影响,以此探讨动脉环内交通动脉代偿机制。 方法　采用MIMICS10.0软件及ANSYS14.5软件,建立了一个包括血管和血流在内的流固耦合的三维有限元模型,模拟了健康模型（颈内动脉无狭窄）及各种病理模型（颈内动脉狭窄率分别为15%、 30%、 45%, 60%、 70%、 80% 和90%）。通过监测前交通动脉和后交通动脉内的血流变化,掌握动脉环内血流动力学的改变。 结果　包括血管和血流的流固耦合有限元模型首次得以建立。随着狭窄率增加,前交通动脉与患侧后交通动脉内血流逐渐增多,狭窄率达到90%后,两条血管内血流减少;健侧后交通动脉内血流也全程逐渐增加,但量极小,基本无明显变化。 结论　通过以上的结果可见,随着颈内动脉狭窄程度的加重,大脑动脉环通过前交通动脉与患侧后交通动脉开放达到代偿,狭窄率达到90%后代偿失效,从机制上印证了颈内动脉狭窄与颅内缺血性病变相关。     

右侧后交通动脉缺如1例

作者在解剖1例男性尸体时发现其右侧后交通动脉缺如(图1),现报道如下:右侧后交通动脉缺如.左侧后交通动脉在视交叉外侧由颈内动脉床突上段的下内侧壁发出(距左侧颈内动脉分叉处0.69 mm,距左侧颈内动脉穿出硬脑膜的距离为8.53 mm),之后沿乳共体外侧穿过脚间池,在后床突上方向后行,与椎基底动脉的左侧大脑后动脉吻合.左侧后交通动脉长1.18 cm,管径1.58mm,均在正常范围之内,无明显变异(国人左侧后交通动脉长度在0.70～2.60 cm,管径在0.40～3.24 mm之间[1]).左侧后交通动脉发出有3支穿支动脉,较粗大的一支为乳头体前动脉,管径为0.33 mm.     

3.0T磁共振血管造影普查对颅内动脉开窗畸形的诊断价值

目的通过大样本病例研究颅内动脉开窗畸形磁共振血管造影(MRA)的检出率、好发部位及其临床意义。方法2009年10月至2011年3月行MRA 2 036例患者,确诊动脉开窗畸形25例(开窗畸形组),其中男性14例,女性11例;年龄30~81岁,平均年龄60.5岁。全部行头颅三维时间飞跃MRA(3D-TOF MRA)扫描,将原始图像经工作站处理,得到最大密度投影(MIP)和容积重组(VR)图像,分析颅内动脉开窗畸形的影像学特点,与伴发动脉瘤之间的相关性。结果 2 036例患者中,发现动脉开窗畸形共计25例(检出率1.23%,25/2 036),其中位于基底动脉11例;位于椎动脉颅内段4例;位于前交通动脉区6例;位于大脑中动脉3例;位于大脑后动脉1例。25例开窗畸形中有6例合并动脉瘤,4例位于颈内动脉颅内段,2例位于大脑前动脉。结论 3D-TOF MRA检查能准确诊断、显示颅内动脉开窗畸形。     

经椎-基底动脉插管建脑梗死模型:beagle犬脑动脉数字减影血管造影表现

背景:因犬颈内动脉入颅之前弯曲度大,呈螺旋形,难以超选择插管,目前犬脑梗死模型往往从颈内动脉灌入自体血栓、明胶海绵等栓塞物质,这种方法建立的模型与人类的脑梗死发病机制相差甚远。椎动脉造影可以清晰显示大脑血管结构,可能会为犬急性脑梗死模型的建立提供新的条件。目的:探索用介入技术经椎-基底动脉途经超选择插管制作beagle犬急性脑梗死模型的可行性。方法:将5只beagle犬分为血栓组(n=3)与对照组(n=2)。血栓组犬经股动脉穿刺插管分别行主动脉弓、颈总动脉与椎动脉数字减影血管造影检查,将2.7F微导管经椎-基底动脉超选择插管至左侧后交通动脉与颈内动脉交通处,注入1条自体血栓条。对照组犬注入适量对比剂。结果与结论:5只犬左、右侧颈总动脉造影可清晰显示粗大的颈外动脉(10/10)及其分支,但只有5条(5/10)颈内动脉在颈总动脉造影时隐约可见显影。颈内动脉管径较细并形成一螺旋形血管袢。左、右椎动脉(10/10)造影可清晰显示椎-基底动脉、"Willis"环、双侧大脑后动脉、大脑中动脉和大脑前动脉。均能将微导管经椎-基底动脉超选择插管至左侧后交通动脉与颈内动脉交通处。磁共振弥散加权成像显示,造模后3 h与6 h血栓组犬左侧大脑颞叶出现局部高信号。说明用椎动脉造影的方法选择经椎-基底动脉途径将微导管超选择插管至beagle犬的左侧大脑中动脉行自体血栓栓塞可成功制作beagle犬急性脑梗死模型,这为选择插管精确栓死beagle犬大脑中动脉提供新方法。     

臀肌悬带解剖学测量及其临床意义

目的测量臀肌悬带的相关解剖学参数,为国人解剖学数据提供资料,同时为临床通过切除臀肌悬带降低坐骨神经麻痹发生率提供解剖学依据。方法选择国人成人尸体下肢标本24例,测量其臀肌悬带以及其与坐骨神经、第1穿动脉、股骨大转子尖和坐骨结节的关系。结果臀肌悬带的长度为(8.68±0.80)cm;悬带的近侧端和股骨大转子尖之间的距离为(6.57±0.92)cm;坐骨结节后尖的臀大肌纤维和悬带近侧端距离为(5.56±0.71)cm;悬带近侧2/3末端与坐骨结节的连线与坐骨神经夹角为(42.2±5.4)°;坐骨神经外侧缘与悬带近、远侧端之间的最小横向距离分别为(2.93±0.56)cm和(2.30±0.42)cm;大转子尖和第1穿动脉的距离为(10.84±0.54)cm;大转子尖和第1穿动脉升支的距离为(8.77±0.58)cm;悬带近端到第1穿动脉的距离为(3.84±0.53)cm;悬带近端到第1穿动脉升支的距离更近,为(1.78±0.93)cm。结论切断悬带近侧端约6cm就足以释放坐骨神经压力而不必完全切除悬带。第1穿动脉特别是其升支与臀肌悬带极为接近,极易受损,解剖分离后者与周围结构时,应极为谨慎。     

大脑内静脉及其属支的磁共振静脉成像

目的 探讨二维时间飞跃法(2D-TOF)磁共振静脉成像(MRV)对大脑内静脉(ICV)及其属支的显示情况,并进行定性和定量研究,构建大脑内静脉三维可视化静脉图谱.方法对62例颅内深静脉正常者进行头颅2D-TOF法MRV检查,所得图像经GE advance Workstation工作站后处理,定性定量分析大脑内静脉及其属...     

椎动脉及大脑后动脉并后交通动脉变异1例

正解剖教学中发现1成年男尸右大脑后动脉有2支,起自基底动脉的右大脑后动脉外径明显小于左大脑后动脉和起自颈内动脉的右大脑后动脉;无右后交通动脉,左后交通动脉发育不良(图1)。描述如下:(1)椎动脉外径差大:双侧椎动脉均起自锁骨下动脉,左/右侧起始处、入枕骨大孔处和末端的外径为分别为3.78 mm/7.52 mm、2.66 mm/6.10 mm和1.74 mm/4.52 mm,起始处至寰椎横突孔上方的距离12.50 cm/12.99 cm。     

球囊闭塞试验在颈内动脉永久闭塞术决策中的参考作用

目的探讨颈内动脉球囊闭塞试验结果与Willis环代偿的关系,以及该试验在颈内动脉永久闭塞术决策过程中的参考作用。方法统计2009年10月至2015年6月我院49名患者52例(侧)颈内动脉球囊闭塞试验的临床资料,分析前交通动脉和后交通动脉出现率与试验阳性率的关系。结果前交通动脉出现率为97.9%,一侧后交通动脉出现率为82.7%。球囊闭塞试验阴性占比92.3%,均有前交通动脉;阳性占比7.7%,其中2例右侧受试侧优势大脑前动脉并同侧后交通动脉缺如,1例左侧受试侧优势大脑前动脉并左侧后交通动脉缺如,1例前交通动脉和后交通动脉均缺如。结论拟闭塞颈内动脉但前交通动脉缺如的病例有必要明确其血流代偿方式;对于Willis环完整的病例实施永久闭塞导致的缺血风险较低。     

腹腔镜前路L5～S1椎间盘手术的血管解剖观察

目的:阐明髂间三角区内血管的分布规律,为腹腔镜前路L5～S1椎间盘手术提供安全靶区。方法:31例经动脉灌注红色乳胶的成人防腐固定腰椎标本,年龄58.2岁。观测并分析髂间三角内与腹腔镜前路L5～S1椎间盘手术相关的血管解剖数据。结果:L5～S1椎间盘的高度、宽度分别为(1.87±0.21)cm、(5.07±0.60)cm;主动脉杈(AB)与髂总静脉汇合处(CCIV)分别位于L5～S1椎间盘上缘(3.97±1.24)cm、(2.75±1.46)cm处;夹角分别为(52.4±12.0)°、(78.4±22.1)°;骶正中动脉(MSA)存在于所有的标本中,在L5～S1椎间盘上、下缘处的外径分别为(0.16±0.04)cm、(0.14±0.05)cm;上、下缘水平到右髂动脉(RIA)的距离分别为(2.02±0.81)cm、(2.74±0.83)cm。左髂静脉(LIV)到右髂动脉的平均距离为3.60cm,占椎间盘宽度的71.3%(32.3%～124.4%)。结论:髂间三角内的血管解剖能满足腹腔镜前路L5～S1椎间盘手术要求,可作为手术治疗椎间盘疾患的选择靶区。     

Willis环三维时间飞跃法磁共振成像的形态、解剖变异及脑底动脉直径测量

通过三维时间飞跃法磁共振成像建立正常国人Willis环的形态、解剖变异及各组成血管直径的正常参考值,探讨其临床意义,决定在Willis环的解剖中是否存在年龄或性别差异。153例健康志愿者和体检者做头MRA检查,显示Willis环,根据其完整情况分为I型(Willis环完整)、II型(Willis环前循环完整后循环不完整)、III型(Willis环前循环不完整后循环完整)、IV型(Willis环前后循环均不完整),根据各血管发育情况,各型又分为典型型、变异型、发育不良型和混合型4种亚型,并对各组成血管直径进行测量。结果表明:153例中,I型占34.64%,II型占47.71%,III型占5.23%,IV型占12.42%。各型及各亚型的年龄、性别差异无显著性。前交通动脉显示率为87.58%,后交通动脉显示率为65.34%,胚胎型大脑后动脉出现率为20.92%。MRA评价Willis环的形态和变异有重要的临床意义,脑底动脉MRA正常值可作为临床判断脑血管疾病的参考。     

视交叉三维断层影像解剖学观察

目的 通过连续横、矢、冠状断层,探讨成人视交叉的位置、形态、毗邻结构及其变化规律,获取视交叉的三维径线和角度数据。方法 20例成人尸体头颅制成头部连续横、矢、冠状断层标本与40例活体成人头部磁共振横、矢、冠状断层扫描图像,探讨视交叉的位置、形态及其毗邻结构;测量视交叉的横径、前后径和上下径,视交叉前角、侧角和后角。 结果 视交叉横断层能同时显示视神经颅内段、视交叉和视束起始段;冠状断层视交叉呈“一”字型横位分隔第三脑室底的视隐窝和漏斗隐窝,其上方是大脑前动脉A1段,下方正中邻垂体柄和灰结节,两侧是颈内动脉C1或C2段;视交叉的横径 (TD_T)为（13.54±3.12）mm,前后径 (APD_T)为（7.91±1.29）mm,上下径 (SID_C)为（3.51±0.49）mm,视交叉前角(AA)为（69.7±9.1）°,左侧角（LLA)为（121.1±16.9）°,右侧角（RLA)为（122.3±15.2）°,后角（PA)为（73.3±10.2）°。断层数据和MRI数据经统计学分析,两者差异无显著性。 结论 连续横、矢、冠状断层和MRI是研究和辨认视交叉、毗邻结构的位置关系及其变化规律的有效方法。     

Some observations on the cerebral arterial circles of mink (Mustela vison)

With the exception of a brief allusion to an unidentified species of Mustela with regard to cerebral vascular studies by de Vriese ('05), major information concerning the circle of Willis in mink was nonexistent until the present investigation. Brains of mink in which the cerebral arterial circles were injected with latex and subsequently hardened in formalin, revealed the primary cerebral arterial anastomosis to be ring-like in form; all of the component vessels were patent and well formed, none was attenuated or string-like. Some of the more prominent findings included: (1) a predominance of asymmetric divergence of the posterior communicating arteries separating from the bifurcating basilar artery; (2) the presence of a posterior intercommunicating artery in all of the specimens; (3) the occasional doubling of the superior cerebellar and the posterior cerebral arteries; (4) deeply placed internal cerebral loops forming secondary arterial anastomoses between some penetrating vessels in the caudal region of the circle; other loops interconnected other penetrating vessels in the rostral region of the circle; (5) blood channels forming an intercarotid anastomosis traversed the pia mater; (6) the presence of a penetrating artery adjunctive to the recurrent artery of Heubner; (7) anastomoses between the internal and the external ophthalmic arteries, and between the internal and the external olfactory arteries forming collateral channels of communication between the intracranial and the extracranial circulations; (8) the occasional presence of an anterior communicating artery supplementing the commonly occurring azygos anterior cerebral artery which continued as a single vessel throughout its extent; (9) unjoined anterior cerebral arteries in one animal which was exceptional.     

The infra-optic course of the anterior cerebral arteries: an anatomic case report

Although variations of the anterior part of the cerebral arterial circle of Willis are quite well known, though some anomalies are exceedingly rare. In a 61-year-old female individual, on both sides the precommunicating parts of the anterior cerebral artery were found to course inferiorly to the ipsilateral optic nerves. This anomaly was associated with an agenesis of a left posterior communicating artery. The anatomic features, the possible high prevalence of associated aneurysms of the anterior communicating artery complex as well as implications for surgical planning or endovascular treatment are outlined and embryologic considerations and discussed.     

The posterior part of the human cerebral arterial circle (CAC): arterial caliber from gestational weeks 13 to 24

Numerous studies have reported that all components of the cerebral arterial circle in the 4-month-old human fetus are more slender than adult vessels, and of equal caliber. After that period, a degree of caliber differentiation is present, especially at the level of the posterior communicating arteries. The aim of this study was to determine arterial diameters in the posterior part of the fetal cerebral arterial circle from the 4th month (IV) to the 6th (VI). One hundred and seventy-two fetal cerebral arterial circles were examined by means of a surgical microscope. It was determined that average diameters of the left (right) pre-communicating parts of the posterior cerebral artery ranged from 0.30 +/- 0.03 (0.29 +/- 0.02) mm in month IV, to 0.36 +/- 0.04 (0.36 +/- 0.03) mm during month V and up to 0.55 +/- 0.22 (0.50 +/- 0.18) mm in month VI. The average diameters of the left (right) posterior communicating artery ranged from 0.24 +/- 0.02 mm (0.25 +/- 0.02) in month IV, to 0.30 +/- 0.03 mm (0.29 +/- 0.05) during month V and up to 0.38 +/- 0.08 (0.44 +/- 0.10) in month VI. Gender differences between posterior cerebral artery and posterior communicating artery diameters were not significant. Average posterior cerebral artery diameters were significantly larger than posterior communicating artery diameters in months IV and V, but not in month VI. It was established that caliber differentiation in the posterior part of the cerebral arterial circle began from gestational month IV, and that gender differences in arterial diameters were not significant until month VI of gestation.     

Overall distribution of vasoactive intestinal polypeptide-containing nerves on the wall of cerebral arteries: an immunohistochemical study using whole-mounts

The overall distribution of vasoactive intestinal polypeptide (VIP)-like immunoreactivity on the wall of the cerebral arteries, including its 3-dimensional profile, was investigated by means of the indirect immunofluorescence method using flat-mounts. VIP-immunoreactive fibers run spirally on the wall of the cerebral arteries. On the wall of the large arteries, such as the vertebral artery, basilar artery, internal carotid artery, within and/or without the circle of Willis, posterior and anterior communicating arteries, proximal parts of anterior, mid and posterior cerebral arteries, these fibers are richly distributed and show a dense grid-like appearance. The highest density was identified on the wall of the anterior cerebral artery, internal carotid artery and anterior communicating artery, while the lowest density was on the posterior communicating artery. On the other hand, on the walls of the branches of these arteries or along distal parts of the anterior, mid and posterior cerebral arteries, the number of VIP-immunoreactive fibers decreased markedly.     

Patterns of reinnervation of denervated cerebral arteries by sympathetic nerve fibers after unilateral ganglionectomy in rats

Summary In order to clarify the manner in which previously denervated cerebral arteries become reinnervated after unilateral excision of the superior cervical ganglion (SCG), we observed directly the reinnervating sympathetic nerve fibers originating in the contralateral SCG by using anterograde labeling with wheat germ aggulutinin-horseradish peroxidase in rats. The nerve fibers sprouted from the nerve fibers in the contralateral anterior cerebral artery and reinnervated the arterial wall of the anterior cerebral artery of the denervated side as early as one week after ganglionectomy. In addition to this sprouting route, three other reinnervating nerve fiber routes were observed in the circle of Willis of the denervated side two weeks after ganglionectomy: the proximal portion of the internal carotid artery, the route passing between bilateral ethmodial arteries, and the posterior communicating artery. Eight weeks after ganglionectomy, these reinnervating nerve fibers formed a fairly dense plexus in a circular pattern in the circle of Willis. However, the reinnervation could not be observed in the arterial branches derived from the circle of Willis (middle cerebral artery and posterior cerebral artery) even 16 weeks after ganglionectomy. The present results clearly demonstrated the time course, distribution pattern and limitation of the reinnervation from the contralateral SCG following unilateral ganglionectomy. The fact that reinnervation could be observed only in the main cerebral arteries of the circle of Willis, in which the nerve plexus appeared to have a circular pattern, suggests a difference between the qualities of sympathetic innervation controlling the cerebral circulation in these arteries and the other arterial branches related to these differences in reinnervation capacity.     

经鼻入路蝶窦外侧壁和海绵窦内侧壁的显微解剖

目的　研究经鼻入路视角下蝶窦外侧壁和海绵窦内侧壁的显微解剖特征,为相关手术提供形态学依据。 方法　10例防腐尸颅按经鼻路径在显微镜下进行解剖,观测视神经、颈内动脉和蝶窦外侧壁的关系,测量前鼻棘与视神经管眶口、颈内动脉隆凸最凸点之间的距离,以及与鼻底平面的角度。 结果　颈内动脉和视神经在蝶窦外侧壁上形成隆凸,两者之间呈“＞”字形,前鼻棘与颈内动脉隆起最凸点之间的距离为（62.18±5.12）mm,与鼻底平面的夹角为（36.8±3.4）°,与视神经管眶口的距离为（69.24±3.95）mm,与鼻底平面的夹角（41.4±3.0）°。颈内动脉海绵窦段可分为鞍旁部和斜坡旁部,鞍旁部与垂体外侧壁关系最为密切,鞍旁部至中线的距离为（9.06±1.34）mm。海绵窦内侧壁由鞍旁部和蝶窦旁部组成。 结论　熟悉蝶窦外侧壁和海绵窦内侧壁的解剖学特点,对于术中定位,安全处理海绵窦病变有重要意义。     

成人胫腓骨下端连接的解剖及其临床意义

目的 解剖胫腓连接并获得详尽的解剖学数据,比较和归纳韧带的特点。方法 选取30具福尔马林固定成人尸体小腿标本,死亡年龄为46～75岁,平均61岁。采用层次解剖法,测量以下数据：胫腓前韧带、胫腓后韧带,胫腓横韧带及骨间韧带的平均长度、宽度、厚度;胫腓前韧带、胫腓后韧带与水平面夹角,与内外踝中点连线夹角。结果 胫腓前韧带平均长度为（18.18±2.64）mm,宽度为（13.28±1.82）mm,厚度（1.98±0.24）mm,与水平面夹角为38°±4°,与内外踝中点连线夹角为33°±3°。胫腓后韧带平均长度为（16.12±2.40）mm,宽度为（11.58±1.98）mm,厚度（2.52±0.32）mm,与水平夹角为31°±5°,与内外踝中点连线夹角为29°±4°。胫腓横韧带平均长度为（24.42±4.54）mm,宽度为（4.96±0.92）mm,厚度为（3.12±0.42）mm;骨间韧带平均长度为（22.24±3.92）mm,宽度为（16.42±2.32）mm,厚度为（1.42±0.44）mm。 结论 揭示了胫腓连接的解剖学特点,为临床应用提供解剖学基础。     

腹腔镜下小儿腹股沟内环口周围的应用解剖学研究

目的　为腹腔镜下小儿腹股沟斜疝修补术提供解剖学依据。 方法　对16具（32侧）经防腐处理的小儿尸体标本内环口周围血管神经进行观测。 结果　（1）髂腹下神经与腹壁下动脉在腹前壁的交点与内环口上缘的距离：男左侧为（16.77±1.36）mm,男右侧为(17.77±2.39)mm;女左侧为(16.41±2.23) 　mm,女右侧为（15.81±0.57）mm。（2）髂腹下神经与腹壁下动脉的夹角：男左侧为(107.75±11.59)°,男右侧为（106.29±8.87)°,女左侧为（106.42±9.46)°,女右侧为(110.23±9.42)°。各测量数据在性别间差异无统计学意义（P >0.05）,各测量数据在双侧无显著性差异（P>0.05）。 结论　（1）在腹前壁髂腹下神经与腹壁下动脉之间有一个没有神经和血管的“安全区域”,该区可为IPOM手术中腹腔镜下补片固定提供足够的安全范围。（2）以腹壁下动脉为参考标志,可减少髂腹下神经的损伤,减少慢性疼痛的发生率。